Provider Demographics
NPI:1952458721
Name:HODGES, DIANNE CUTRERA (RN,LAC)
Entity Type:Individual
Prefix:MRS
First Name:DIANNE
Middle Name:CUTRERA
Last Name:HODGES
Suffix:
Gender:F
Credentials:RN,LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 DULLES DR STE 1
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-3008
Mailing Address - Country:US
Mailing Address - Phone:337-262-5870
Mailing Address - Fax:337-262-1272
Practice Address - Street 1:302 DULLES DR STE 1
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-3008
Practice Address - Country:US
Practice Address - Phone:337-262-5870
Practice Address - Fax:337-262-1272
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA502101YA0400X
LARN31949163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA623Medicare UPIN